Feyza Aksu

Is serum Klotho protective against atherosclerosis in patients with type 1 diabetes mellitus

OBJECTIVE Klotho deficiency is associated with several metabolic disorders. Two dimensional (2D) longitudinal strain (LS) of left ventricle (LV), carotid artery intima-media thickness (CIMT), flow-mediated dilation (FMD) of brachial artery and epicardial fat thickness (EFT) have been reported to be early predictors of atherosclerosis. We aimed to investigate the relationship between serum Klotho levels and these early predictors of atherosclerosis in patients with type 1 diabetes mellitus (DM). METHODS The study included 45 type 1 diabetic patients and 35 controls. Serum Klotho levels were determined by ELISA method. The patient group was also divided into two subgroups according to serum Klotho levels: high (HK) and low Klotho (LK) groups. EFT, CIMT and FMD were measured according to appropriate recommendations. Speckle tracking analysis was performed using the Echopac software. RESULTS The patient group had significantly lower serum Klotho (p=0.001), FMD (p<0.001) and LS of LV (p<0.001) values, but larger EFT (p<0.001) and CIMT (p<0.001) values than controls. LK subgroup had also significantly lower FMD (p<0.001) and LS of LV (p<0.001) but larger EFT (p=0.002) and CIMT (p<0.001) values than HK subgroup. CONCLUSION Serum Klotho may have a protective effect against atherosclerosis and endothelial dysfunction in type 1 DM.

Morning blood pressure surge is associated with carotid intima-media thickness in prehypertensive patients

Objective Morning blood pressure (BP) surge (MBPS) is defined as an excessive increase in the morning BP from the lowest systolic BP during sleep and is reported as a risk factor for cardiovascular events in current clinical studies. In this study, we aimed to investigate the relationship between MBPS and carotid intima-media thickness (C-IMT) in prehypertensive patients. Patients and methods We evaluated the association between the rate of BP variation derived from ambulatory BP monitoring and C-IMT in patients with prehypertension. Results One hundred and seventy patients with prehypertension were included in the study. All office BP measurements and ambulatory 24-h, day-time, and night-time measurements were similar between each group. C-IMT [0.60 (range: 0.57–0.65) vs. 0.55 (range: 0.50–0.60) cm; P<0.001] and the mean platelet volume [8.7 (range: 7.9–9.1) vs. 7.9 (range: 7.3–8.8)  fl; P=0.002] were significantly higher in the greater MBPS group than the lower group. In multivariate analysis, male sex [odds ratio (OR): 2.271, confidence interval (CI): 1.011–5.100, P=0.047], greater MBPS (OR: 8.474, CI: 3.623–19.608, P<0.001), and elevated mean platelet volume levels (OR: 3.359, CI: 1.978–5.705, P<0.001) were found to be independent predictors of greater C-IMT in prehypertensive patients. Conclusion Our study suggests that greater MBPS is associated independently with C-IMT in prehypertensive patients.

Effects of sphingosylphosphorylcholine against oxidative stress and acute lung ınjury ınduced by pulmonary contusion in rats

BACKGROUND/PURPOSE The goal of this study was to evaluate effects of exogenous sphingosylphosphorylcholine (SPC) administration on acute lung injury induced by pulmonary contusion in rats. METHODS Eight animals were included in each of the following five groups: control, contusion, contusion phosphate-buffered solution (PBS), contusion SPC 2, contusion SPC 10. SPC was administered 3 days at a daily two different doses of 2 μm/ml and 10 μm/ml intraperitoneally. The severity of lung injury was determined by the neutrophil activation and histological and immunohistochemical changes in the lung. Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione (GSH) were determined to evaluate the oxidative status in the lung tissue. RESULTS Treatment with 2 μM SPC inhibited the increase in lung MDA and NO levels significantly and also attenuated the depletion of SOD, GPx, and GSH in the lung injury induced by pulmonary contusion. These data were supported by histopathological findings. The inducible nitric oxide synthase (iNOS) positive cells and apoptotic cells in the lung tissue were observed to be reduced with the 2 μM SPC treatment. But, the 10 μM SPC treatment did not provide similar effects. CONCLUSIONS In conclusion, these findings suggested that 2 μM SPC can attenuate lung damage in pulmonary contusion by prevention of oxidative stress, inflammatory process and apoptosis. All these findings suggest that low dose SPC may be a promising new therapeutic agent for acute lung injury.

Desferrioxamine Reduces Oxidative Stress in the Lung Contusion

Our hypothesis in this study is that desferrioxamine (DFX) has therapeutic effects on experimental lung contusions in rats. The rats were divided into four groups (n = 8): control, control+DFX, contusion, and contusion+DFX. In the control+DFX and contusion+DFX groups, 100 mg/kg DFX was given intraperitoneally once a day just after the contusion and the day after the contusion. Contusions led to a meaningful rise in the malondialdehyde (MDA) level in lung tissue. MDA levels in the contusion+DFX group experienced a significant decline. Glutathione levels were significantly lower in the contusion group than in the control group and significantly higher in the contusion+DFX group. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) levels in the contusion group were significantly lower than those in the control group. In the contusion+DFX group, SOD and GPx levels were significantly higher than those in the contusion group. In light microscopic evaluation, the contusion and contusion+DFX groups showed edema, hemorrhage, alveolar destruction, and leukocyte infiltration. However, histological scoring of the contusion+DFX group was significantly more positive than that of the contusion group. The iNOS staining in the contusion group was significantly more intensive than that in all other groups. DFX reduced iNOS staining significantly in comparison to the contusion group. This study showed that DFX reduced oxidative stress in lung contusions in rats and histopathologically ensured the recovery of the lung tissue.

Antioxidant and renoprotective effects of sphingosylphosphorylcholine on contrast-induced nephropathy in rats

Abstract Contrast induced nephropathy (CIN) is a major cause of morbidity, and increased costs as well as an increased risk of death. This study was evaluated effects of exogenous sphingosylphosphorylcholine (SPC) administration on CIN in rats. Eight animals were included in each of the following eight groups: control, control phosphate-buffered solution (PBS), control SPC 2, control SPC 10, CIN, CIN PBS, CIN SPC 2 and CIN SPC 10. The induced nephropathy was created by injected with 4 g iodine/kg body weight. SPC was administered 3 d at a daily two different doses of 2 μm/mL and 10 μm/mL intraperitoneally. The severity of renal injury score was determined by the histological and immunohistochemical changes in the kidney. Malondialdehyde (MDA), nitric oxide (NO) and superoxide dismutase (SOD) were determined to evaluate the oxidative status in the renal tissue. Treatment with 2 and 10 μM SPC inhibited the increase in renal MDA, NO levels significantly and also attenuated the depletion of SOD in the renal injuryCIN. These data were supported by histopathological findings. The inducible nitric oxide synthase positive cells and apoptotic cells in the renal tissue were observed to be reduced with the 2 and 10 μM SPC treatment. These findings suggested that 2 and 10 μM doses can attenuate renal damage in contrast nephropathy by prevention of oxidative stress and apoptosis. The low and high dose SPC may be a promising new therapeutic agent for CIN.

Retrobulbar blood flow and carotid intima–media thickness alteration may relate to subclinic atherosclerosis in patients with chronic inflammatory diseases

Abstract Objective: AA amyloidosis occurs in the setting of longstanding inflammation. An increased incidence of coronary artery disease (CAD) was noted in patients with chronic inflammatory disease (CID). Retrobulbar blood flow predicts future macrovascular events including CAD. Increase in carotid artery intima–media thickness is regarded as a marker for early atherosclerosis. The relationship between chronic inflammation and atherosclerosis is well known; however, the connection between amyloidosis-advanced CIDs and retrobulbar microvascular function and carotid intima–media thickness (CIMT) is unidentified. We aimed to investigate whether retrobulbar microcirculation and CIMT were impaired or not in amyloidosis-advanced CID patients compared to normal subjects. Methods: Fourteen patients with renal AA amyloidosis and a group of healthy volunteers were included in the study. Measurement of CIMT and retrobulbar blood flow velocities was performed with ultrasound scanner and color Doppler ultrasonography. Results: The CIMT of patients with renal amyloidosis was significantly thicker than that of the normal population (p < 0.001). The resistivity index of the ophthalmic artery (OA) of patients with renal amyloidosis was significantly higher than the study group (p < 0.001). Conclusion: This study demonstrates that accelerated atherosclerosis which can be shown by increased OA resistivity index and CIMT are found in amyloidal-related CID patients.

Demonstration of a persistent left superior vena cava by transthoracic echocardiography using agitated saline injection

A 72-year-old man underwent transthoracic echocardiography (TTE) for evaluation of a holosystolic murmur heard best at the apex. TTE revealed an enlarged coronary sinus (28 mm × 24 mm), a mild degree of aortic stenosis and regurgitation, as well as pulmonary hypertension. Because of the enlarged coronary sinus, we performed contrast echocardiography to determine whether there was an associated persistent left superior vena cava (PLSVC). Injection of agitated saline into the right antecubital vein resulted in contrast entering into the right atrium through the normal superior vena cava (Figure 1). However, injection through the left antecubital vein resulted in opacification of the dilated coronary sinus and subsequently the right atrium (Figure 2). TTE performed with agitated saline injection may easily demonstrate PLSVC, which is a rare coronary sinus anomaly. Although it usually requires no treatment, the majority of patients with PLSVC are at risk of paradoxical embolism because of accompanying lesions such as atrial septal defect, unroofed coronary sinus and direct communication of the vein to the left atrium. In daily practice, PLSVC may be responsible for difficulties in central venous catheterization and pacemaker electrode placement. Therefore, its diagnosis with the aid of a simple and easy technique, such as TTE with agitated saline injection, may be extremely helpful for physicians who perform device implantation. Figure 1) Injection of agitated saline into the right antecubital vein resulting in contrast entering into the right atrium through the normal superior vena cava. CS Coronary sinus; LV Left ventricle; RA Right atrium; RV Right ventricle Figure 2) Injection through the left antecubital vein resulting in opacification of a dilated coronary sinus (CS) before reaching the right atrium (RA). LA Left atrium, LV Left ventricle; RV Right ventricle

Evaluation of Cardiovascular Risk Factors, Haematological and Biochemical Parameters, and Serum Endocan Levels in Patients with Lichen Planus.

Background and Objective: The current study aimed to evaluate cardiovascular risk factors, haematological and biochemical parameters, and serum endocan concentrations in lichen planus (LP) patients. Methods: This study was conducted with 86 cases, including 43 LP patients and 43 healthy controls. Cardiovascular risk factors, haematological and biochemical parameters, and endocan levels were evaluated. Results: The serum endocan concentrations of LP patients were not significantly different from those of the healthy controls (p > 0.05). There were no significant differences in the serum endocan levels according to classification by cardiovascular risk factors and smoking history (p > 0.05). In the LP group, white blood cell count, platelet distribution width and monocyte count/high-density lipoprotein cholesterol ratios were significantly higher when compared to the healthy controls (p < 0.05). The LP group had a lower mean platelet volume than the healthy controls (p < 0.05). Conclusions: Serum endocan levels did not change significantly in patients with LP, and there were significant differences in haematological and biochemical parameters.

Echocardiographic Epicardial Fat Thickness Measurement and Cardiovascular Risk Assessment in Patients with Systemic Lupus Erythematosus

received: 24.02.2016 Accepted: 06.04.2016 1Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology 2Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Internal Medicine 3Iskilip Atif Hoca State Hospital, Department of Cardiology Yazışma adresi: Nurşen Keleş, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, Istanbul e-mail: drnursenkeles@yahoo.com.tr aBStract

Current Approaches to the Diagnosis and Treatment of Resistant Hypertension

Hipertansiyonu olan hastalar, lipid bozuklukları, glukoz tolerans bozukluğu veya diyabet, ailede erken kardiyovasküler olay öyküsü, obesite ve sigara içiciliği gibi diğer birçok risk faktörüne de sahiptirler. Hipertansiyon tanı ve tedavisine yönelik çok sayıda klavuz yayımlanmış olmasına rağmen, toplumların önemli bir kısmında hipertansiyon tedavisinde sınırlı bir başarı elde edilmiştir. Bu bağlamda tedavi altındaki hastaların yarısından daha az bir kısmında beklenen kan basıncı kontrolü elde edilebilmiştir1.